Provider Demographics
NPI:1689809055
Name:HAGEN BOWLES, BETHANY LYNN (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LYNN
Last Name:HAGEN BOWLES
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:LYNN
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDMT
Mailing Address - Street 1:18 AMDS UNIT 5267
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368-5267
Mailing Address - Country:US
Mailing Address - Phone:01181611-730-4229
Mailing Address - Fax:
Practice Address - Street 1:18 AMDS UNIT 5267
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5267
Practice Address - Country:US
Practice Address - Phone:01181611-730-4229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians